Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

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Saturday, July 12, 2008

Some decades ago, soon after finishing residency, I had what is still my "best save"..We all have one.

Sunday evening in the ED. Call comes in on a hot load, victim of drunk driver on the interstate.

The patient was a 30ish male. Completely FUBAR. Bilateral flails, pnuemo's, EVERY long bone in body broken, pelvic diastasis with urethral disruption, gross blood on DPL(no CT scan back then) I mean every thing in this guy is completely fucked up, except his brain and spine!

If I remember correctly he had about 12 units of blood before going to the OR. But we saved his life and he walked out of the hospital some weeks later. No way this guy should be alive...

But the story changes a bit..Turns out THIS was the DRUNK! He tried to enter the freeway from an exit! And killed a young Mom, Dad and 2 small children..

Aw, thanks, 911, for thinking of us. Thanks for the translation, farty. I can't imagine the compartmentalization it must take to be a doc, especially when it comes to saving people who caused death and destruction. My instincts would be to let the bastid bleed out. But then I'm a civilian.

This is one reason I'm m not practicing law: I got a child abuser off and got kids returned to her custody. Turns out charges were substantiated. I was so convinced of her innocence that I supervised one of her visitations myself.

we just had one at the beginning of the month: a guy ditched his motorcycle on the highway, and as he was rolling around, trying to get up, a semi came and hit him, and threw him 100 feet. He got 6 units of PRBC in the helicopter, and then arrived at the institution I'm rotating at this month. we proceeded to CT him in the pan-scan, and he had the worst pelvic fracture that anyone had ever seen (including the trauma surgeon, who has about 25 years experience). He had a vertical shear injury with about 20 cm of displacement and put his blood volume into the gap between his pelvic bones. After about the 56th unit of PRBC, we decided to take him to angio (which was a nightmare), and they angio'd his common iliac to stop the bleeding, and then took him for a hemipelvectomy.

he's still alive, and responsive on the vent today, and may actually survive this.

whitecap nurse says: Please NEVER assume one way or the other whether your patient is victim or perp, drunk or not. I can remember three patients (when I was a medic) who I thought were sh*t-faced drunk who were in fact completely sober. #1 collapsed while walking out of a liquor store, his bottle of whiskey broke all over him - he turned out to be in perfusing VT. #2 Young father brought in after an MVA in which is daughter was killed. Again, bottle of beer broke during the accident so he reeked. BA was 0.00. #3 reported to be a solo drunk driver crash, found sort of half-in, half-out of the car, very altered. Turned out to be auto-ped victim, head injury.